Homestead_Kissel_ , CLAIM FOR HOMESTEAD PROPERTY:TAX. -� -- --� FORM
CREDIT/STANDARD DEDUCTION ' ' -' ' - HCto
t y • SLnt Fonn 5379 (R6 /l-03) . �.. . � � rn� .
Prescribed by the Department o( local Govemm�nt Finano: `�' � � � ' ' . ` � " ' � •
INSTRUCiIONS: See revmsr, sidedorliling irishucliun;:✓ � ' , �- -i � _ . , . . . • .
y
YEAR
� �we) F'l � � . 1 '
i o h s da f March, 20
I(We) occupied as our 'ncip I lace of residence the following described real property for which a Homestead Property Tac Credit is hereby Gaimed:
�(We)owned � Arebuyingunderwntract APR 2$ ZOOS
` Have a benefidal interest in Ihe entiry �hat is Iiable (or ihe property taxes on the property and �that owns lhe property or is buying under a wntract.
If buying om m�uaa. Fee S'unple ownefs name
Remrders olfica where contratt is
County
Parcel number
Qo�-oa►b4-ce
If zny portion cl Ne residenVal s•uuciure m
.af the property uul"¢ed lo produca incoma.
County
7avnship
Legat descriptbn
Ut a�- }—��___� ap
na excaeding one (7) aae tAat immediatety
_,,��,_
IP,TION�:'a �`^r�_"''�,•':.g<. ,•
district (dry, fown, township)
Counry
�rv i r aUDITOR ; `•.==:: "'.:
Record numher Page
. � '=v'� "^'��. -. "
property i�eslion:
Real propeRy ' ❑ Mo�ile Homo (I.C. b1J-7)
thal sWCNre is used to produce income, descnbe Ihe use antl ponion
�a��-
I hereby certify the above statements are We, correct and wmplete.� � ature of,qlaimant „'
/-% �/
��idr s um6eiar�dsVeef,city,stafe,2lPcode) �
R.�_ B��/��-,��1 r�. t3r�� z�v �/�l�
y�`�'�"�v�-;k� ��Ry''��`����j'� � x �`�� `TRUETAX� �� �ASSESSED�VALUE +HOMESTEAD�A� �?,r�%-NON-RESIDENTIAL�,�,"'+ �'
s��-�'P_-f�3 `�� ASSESSOR�SE ONLx,�.�+j.-1�z�.�'G�i� aYk-isaVALUE �,` rv: _/iT 700/'OF�TTV -���,�.-=x?��VALUE�,t�r�"•�. 4�a%3::�a i 1�VALUE �,:..'?. -�`'�:3� �_"
Land not exceeding 1(one) acre.immediatety � E e�" �+x'�i ^. "'�'�»*Y, :. -g� ' S'z
surrounding residential improvemenis. �� � a.r`���,'�n� t,;. �� .; .'�:. F#� }:'�.
Other land � t � i �
(Z) _
� ��"�� ^-�..�,"9"�"{:
"v�y.'i. �'- „ :
- Total land (line 1 plus line 2) (g�
� Dwelling (4) p �F`�'�rr}'�,'1�;•�M �
ResidentielimprovementsaMnually - �{ ��A�'�'��'''�;t�"'"�'�''9��
0.ssessed MoWielManufaUUrad Home� Garage (5) ��� #'"�*`�,,r,�`rc� `� s�,,,�.�r:
< rt'��a. n �_�#r... .�rFa. -:
Other improvements (6) -. '> y���'h�";`��
�1k'..c�)'::[� ��y..Ti��
Tdal improvemenLS (line 4 fhrough line 6) �7)
Tdal value (line 3 pl�s line n (8)
I hereby ceAify Ihe above is We, correcf, and Signamre otnssessor Date signed
complete.
Verifying action - SignaW re oflwdilor Date signed
n'�,d�.�.-'.:��� �.t. ,.��`,•sJ w��°`a�.L`:.�*.�` t..,._STANDARD':DEDUCTION��ALI:OWANCE � r::.;�;rh:s��`.�°.;wti._f � i;� w�.:�,��.�.g,t _r �...�.
- �u'.3r-�,r-.ca..i . n:rv..:`:
20 Pay 20 _
. Lesser oi 12 Homesteatl
vawauon or 535.000
S
SgnaWroofAUtldw ' Datesigned